{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:56:00Z","timestamp":1785390960976,"version":"3.55.0"},"reference-count":61,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T00:00:00Z","timestamp":1670457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>This study aimed to assess the trends and determine the factors associated with late presentation (LP) and advanced HIV disease (AHD) among newly diagnosed people living with HIV (PLWH) from 2008 to 2020 in Jiangsu, China.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Newly diagnosed PLWH registered in the HIV surveillance system from 2008 to 2020 were included. Multivariable logistic regression models were used to analyze the factors associated with LP and AHD. The LP and AHD trends were assessed using Joint-point analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 37,251 newly diagnosed PLWH identified, 30,251(81.2%) patients met the inclusion criteria. Among those, 16,672 (55.1%) were considered LP, and 8,691 (28.7%) had AHD. LP trends steadily increased from 2008 (39.0%) to 2020 (59.4%), but AHD trends decreased visibly from 2016 (32.3%) to 2020 (23.4%). The overall median CD4 trends decreased slowly from 389 to 305 cells\/mm<jats:sup>3<\/jats:sup> between 2008 and 2020. Married patients and those older than 35 years were more likely to be LP and have AHD. Patients infected via heterosexual transmission had a higher risk of being classified as AHD (aOR: 1.13, 95%CI: 1.06\u20131.21) than patients infected via homosexual transmission. Patients that were diagnosed at sexually transmitted infections (STIs) clinics (aOR: 1.10, 95%CI: 1.01\u20131.20) and in hospitals (aOR: 1.69, 95%CI: 1.59\u20131.79) were more likely to be classified as LP compared with patients diagnosed at voluntary counseling and testing (VCT) centers. Similar, patients diagnosed at STIs clinics (aOR: 1.23, 95%CI: 1.11\u20131.36) and hospitals (aOR: 2.27, 95%CI: 2.12\u20132.43) were more likely to have AHD than patients diagnosed in VCT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings indicate an alarming burden of LP in Jiangsu, suggesting the need for more attention toward HIV diagnosis at early CD4 stages. National HIV control programs must strengthen comprehensive interventions for HIV prevention and promote HIV services. Also, strategies for HIV prevention (PrEP and PEP), testing, and treatment must be extended, especially among the general population.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2022.1054765","type":"journal-article","created":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T12:42:05Z","timestamp":1670503325000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":21,"title":["Trends of late HIV presentation and advance HIV disease among newly diagnosed HIV cases in Jiangsu, China: A serial cross-sectional study from 2008 to 2020"],"prefix":"10.3389","volume":"10","author":[{"given":"Lingen","family":"Shi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiming","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiyang","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuheng","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqin","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunting","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gengfeng","family":"Fu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,12,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1186\/s12981-021-00415-2","article-title":"Hiv\/Aids late presentation and its associated factors in china from 2010 to 2020: a systematic review and meta-analysis","volume":"18","author":"Sun","year":"2021","journal-title":"Aids Res Ther."},{"key":"B2","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s12981-019-0221-7","article-title":"Hiv late presentation and advanced hiv disease among patients with newly diagnosed hiv\/aids in southwestern china: a large-scale cross-sectional study","volume":"16","author":"Hu","year":"2019","journal-title":"Aids Res Ther."},{"key":"B3","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1080\/09540121.2019.1640848","article-title":"The moderator effect of retention in care on late presentation in HIV-infected patients","volume":"32","author":"Li","year":"2020","journal-title":"Aids Care."},{"key":"B4","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1111\/hiv.12403","article-title":"The late-presenting hiv-infected patient 30 years after the introduction of HIV testing: spectrum of opportunistic diseases and missed opportunities for early diagnosis","volume":"18","author":"Tominski","year":"2017","journal-title":"HIV Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1186\/s12879-018-3204-8","article-title":"Late presentation to hiv\/aids care at the douala general hospital, cameroon: its associated factors, and consequences","volume":"18","author":"Luma","year":"2018","journal-title":"Bmc Infect Dis."},{"key":"B6","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s15010-018-1167-8","article-title":"Travellers refugees and family-reunified immigrants have a high incidence of hiv diagnosis and late presentation compared with Danish born: a nationwide register-based cohort","volume":"46","author":"Deen","year":"2018","journal-title":"Study Infect."},{"key":"B7","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s12981-016-0129-4","article-title":"Late presentation increases risk and costs of non-infectious comorbidities in people with HIV: an Italian cost impact study","volume":"14","author":"Guaraldi","year":"2017","journal-title":"Aids Res Ther."},{"key":"B8","doi-asserted-by":"publisher","first-page":"S83","DOI":"10.1080\/09540121.2014.906554","article-title":"Frequency and correlates of late presentation for hiv infection in France: older adults are a risk group - results from the Anrs-Vespa2 Study, France","volume":"1","author":"Wilson","year":"2014","journal-title":"Aids Care."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1632","DOI":"10.1007\/s10461-013-0426-z","article-title":"Hiv transmission in the united states: considerations of viral load, risk behavior, and health disparities","volume":"17","author":"Hall","year":"2013","journal-title":"Aids Behav."},{"key":"B10","doi-asserted-by":"publisher","first-page":"355","DOI":"10.14423\/SMJ.0000000000000819","article-title":"Cost-effectiveness analysis of early vs late diagnosis of hiv-infected patients in South Carolina","volume":"111","author":"Rampaul","year":"2018","journal-title":"South Med J."},{"key":"B11","doi-asserted-by":"publisher","first-page":"2654","DOI":"10.1093\/jac\/dkw196","article-title":"Cd4 cell count at initiation of art, long-term likelihood of achieving cd4 >750 cells\/mm3 and mortality risk","volume":"71","author":"Palella","year":"2016","journal-title":"J Antimicrob Chemother."},{"key":"B12","doi-asserted-by":"publisher","first-page":"2325958219847199","DOI":"10.1177\/2325958219847199","article-title":"Advanced Hiv disease among males and females initiating Hiv care in rural Ethiopia","volume":"18","author":"Lifson","year":"2019","journal-title":"J Int Assoc Provide Aids Care."},{"key":"B13","doi-asserted-by":"publisher","first-page":"E540","DOI":"10.1016\/S2352-3018(19)30189-4","article-title":"Advanced Hiv: diagnosis, treatment, and prevention","volume":"6","author":"Prabhu","year":"2019","journal-title":"Lancet Hiv."},{"key":"B14","doi-asserted-by":"publisher","first-page":"S106","DOI":"10.1093\/cid\/cix1139","article-title":"Managing advanced HIV disease in a public health approach","volume":"66","author":"Ford","year":"2018","journal-title":"Clin Infect Dis."},{"key":"B15","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1136\/sextrans-2018-053932","article-title":"HIV testing barriers and intervention strategies among men, transgender women, female sex workers and incarcerated persons in the caribbean: a systematic review","volume":"96","author":"Hamilton","year":"2020","journal-title":"Sex Transm Infect."},{"key":"B16","doi-asserted-by":"publisher","first-page":"E139","DOI":"10.1016\/S2352-3018(22)00040-6","article-title":"Time to tackle late diagnosis","volume":"9","year":"2022","journal-title":"Lancet Hiv."},{"key":"B17","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1186\/s12879-020-05261-7","article-title":"Estimating the burden of Hiv late presentation and its attributable morbidity and mortality across Europe 2010\u20132016","volume":"20","year":"2020","journal-title":"BMC Infect Dis"},{"key":"B18","first-page":"1004","article-title":"Analysis on late diagnosis reasons of newly diagnosed Hiv\/Aids patients","volume":"46","author":"Tang","year":"2012","journal-title":"Chinese J Prevent Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1111\/hiv.12686","article-title":"Late diagnosis, delayed presentation and late presentation among persons enrolled in a clinical Hiv cohort in Ontario, Canada (1999-2013)","volume":"20","author":"Wilton","year":"2019","journal-title":"HIV Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"E0249864","DOI":"10.1371\/journal.pone.0249864","article-title":"Late presentation for Hiv remains a major health issue in Spain: results from a multicenter cohort study, 2004-2018","volume":"16","author":"Rava","year":"2021","journal-title":"Plos One"},{"key":"B21","doi-asserted-by":"publisher","first-page":"E2169","DOI":"10.7717\/peerj.2169","article-title":"Hiv\/Stis risks between migrant msm and local msm: a cross-sectional comparison study in China Peerj","volume":"4","author":"Wu","year":"2016"},{"key":"B22","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1111\/j.1468-1293.2010.00857.x","article-title":"Late Presentation of Hiv infection: a consensus definition","volume":"12","author":"Antinori","year":"2011","journal-title":"HIV Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1002\/(sici)1097-0258(20000215)19:3<335::aid-sim336>3.0.co;2-z","article-title":"Permutation tests for joinpoint regression with applications to cancer rates","volume":"19","author":"Kim","year":"2000","journal-title":"Statistics Med"},{"key":"B24","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1111\/j.1541-0420.2006.00662.x","article-title":"Modified bayes information criterion with applications to the analysis of comparative genomic hybridization data","volume":"63","author":"Zhang","year":"2007","journal-title":"Biometrics."},{"key":"B25","unstructured":"Strengthen the Prevention and Control of Aids.2011"},{"key":"B26","doi-asserted-by":"publisher","first-page":"269","DOI":"10.3760\/cma.j.cn112338-20200624-00882","article-title":"Changing trends of hiv Testing and hiv self-testing in men who have sex with men on a gay social networking app","volume":"42","author":"Wu","year":"2021","journal-title":"Chinese J Epidemiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1071\/SH20038","article-title":"Factors influencing the acceptability of hiv\/aids voluntary counseling and testing: a quantitative study of 41336 female university students in China","volume":"18","author":"Liang","year":"2021","journal-title":"Sex Health."},{"key":"B28","doi-asserted-by":"publisher","first-page":"254","DOI":"10.3760\/cma.j.cn112338-20210616-00477","article-title":"Effects of unsafe sexual behavior and sexual orientation on previous hiv testing and hiv testing willingness among college students in Harbin","volume":"43","author":"Zhao","year":"2022","journal-title":"Chinese J Epidemiol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1111\/hiv.12727","article-title":"Why do sub-saharan africans present late for Hiv care in Switzerland?","volume":"20","author":"Hachfeld","year":"2019","journal-title":"HIV Med."},{"key":"B30","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1002\/hpja.168","article-title":"Hiv knowledge and use of health services among people from South-East Asia and sub-saharan Africa living in Western Australia health","volume":"29","author":"Gray","year":"2018","journal-title":"Promot J Austr."},{"key":"B31","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1186\/s12879-022-07189-6","article-title":"Hiv testing frequency and associated factors among five key populations in ten cities of China: a cross-sectional study","volume":"22","author":"Jiao","year":"2022","journal-title":"Bmc Infect Dis."},{"key":"B32","doi-asserted-by":"publisher","first-page":"S53","DOI":"10.1097\/QAD.0000000000002565","article-title":"Hiv stigma by association among australian gay and bisexual men aids","volume":"1","author":"Broady","year":"2020","journal-title":"Suppl."},{"key":"B33","doi-asserted-by":"publisher","first-page":"707","DOI":"10.3760\/cma.j.issn.0254-6450.2018.06.002","article-title":"Characteristics of hiv sexually transmission and challenges for controlling the epidemic in China","volume":"39","author":"Wu","year":"2018","journal-title":"Chinese J Epidemiol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"E9731","DOI":"10.7717\/peerj.9731","article-title":"Older adults at high risk of Hiv infection in China: a systematic review and meta-analysis of observational studies","volume":"8","author":"Wang","year":"2020","journal-title":"PeerJ."},{"key":"B35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/09540121.2022.2060493","article-title":"Hiv Testing and related factors among 50 years and older msm in China: results from a cross-sectional study","volume":"2","author":"Lian","year":"2022","journal-title":"Aids Care"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1900","DOI":"10.1186\/s12889-021-11948-6","article-title":"Factors related to Hiv testing frequency in msm based on the 2011-2018 survey in Tianjin, China: a hint for risk reduction strategy","volume":"21","author":"Liu","year":"2021","journal-title":"BMC Public Health."},{"key":"B37","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1007\/s10461-019-02640-3","article-title":"How bachelorhood and migration increase the HIV transmission risk through commercial sex in China?","volume":"24","author":"Xiao","year":"2020","journal-title":"Aids Behav"},{"key":"B38","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1186\/s12879-017-2367-z","article-title":"Disparities in Hiv and syphilis prevalence and risk factors between older male clients with and without steady sex partners in southwestern rural China","volume":"17","author":"Chen","year":"2017","journal-title":"Bmc Infect Dis."},{"key":"B39","doi-asserted-by":"publisher","first-page":"919","DOI":"10.1186\/s12889-020-09021-9","article-title":"Declining trend in Hiv new infections in guangxi, china: insights from linking reported Hiv\/Aids cases with Cd4-At-diagnosis data","volume":"20","author":"Sun","year":"2020","journal-title":"BMC Public Health."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.13419\/j.cnki.aids.2020.11.20","article-title":"Application of spectrum\/Epp model in Hiv\/Aids epidemic trend assessment of Yunnan Province","volume":"26","author":"Xiao","year":"2020","journal-title":"Chinese J Aids And Std"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.3760\/cma.j.issn.0254-6450.2019.10.004","article-title":"National Hiv\/aids epidemic estimation and interpretation in China","volume":"40","author":"Lyu","year":"2019","journal-title":"Chinese J Epidemiol"},{"key":"B42","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1111\/j.1468-1293.2011.00974.x","article-title":"The rate of Hiv testing is increasing among men who have sex with men in China","volume":"13","author":"Chow","year":"2012","journal-title":"Hiv Med."},{"key":"B43","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1007\/s11904-019-00478-x","article-title":"Optimizing treatment for adults with HIV\/aids in China: successes over two decades and remaining challenges","volume":"17","author":"Cao","year":"2020","journal-title":"Curr Hiv\/Aids Rep."},{"key":"B44","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1007\/s11904-019-00469-y","article-title":"Interventions to improve the HIV continuum of care in China","volume":"16","author":"Zhang","year":"2019","journal-title":"Curr HIV\/AIDS Rep."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1080\/09540121.2014.902420","article-title":"Attrition of Msm with Hiv\/Aids along the continuum Of care from screening To Cd4 testing in China","volume":"26","author":"Zhang","year":"2014","journal-title":"AIDS Care."},{"key":"B46","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1136\/sextrans-2013-051397","article-title":"A peer-led, community-based rapid hiv testing intervention among untested men who have sex with men in China: an operational model for expansion of HIV testing and linkage to care","volume":"90","author":"Yan","year":"2014","journal-title":"Sexually Transmitt Infect."},{"key":"B47","doi-asserted-by":"publisher","first-page":"2029","DOI":"10.1186\/s12889-021-12048-1","article-title":"Predictors of late presentation and advanced Hiv disease among people living with Hiv in Oman (2000-2019)","volume":"21","author":"Elgalib","year":"2021","journal-title":"BMC Public Health."},{"key":"B48","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1089\/aid.2015.0058","article-title":"Late presentation into care of hiv disease and its associated factors in Asia: results of Tahod","volume":"32","author":"Jeong","year":"2016","journal-title":"AIDS Res Hum Retroviruses."},{"key":"B49","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1111\/hiv.12762","article-title":"Long-term trends in Hiv care entry: over 15 years of clinical experience from Poland","volume":"20","author":"Siwak","year":"2019","journal-title":"HIV Med."},{"key":"B50","doi-asserted-by":"publisher","first-page":"878","DOI":"10.1186\/s12889-016-3477-z","article-title":"The risk of late or advanced presentation of hiv infected patients is still high, associated factors evolve but impact on overall mortality is vanishing over calendar years: results from the Italian master cohort","volume":"16","author":"Raffetti","year":"2016","journal-title":"BMC Public Health."},{"key":"B51","doi-asserted-by":"publisher","first-page":"177","DOI":"10.13419\/j.cnki.aids.2021.02.16","article-title":"Factors influencing the late detection of hiv infection cases in Qujing from 2014 To 2019","volume":"27","author":"Qiu","year":"2021","journal-title":"Chinese J Aids Std"},{"key":"B52","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.13419\/j.cnki.aids.2019.11.15","article-title":"Late diagnosis of newly identified hiv\/aids cases and influencing factors in Jiangxi Province during 2014 And 2018","volume":"25","author":"Yang","year":"2019","journal-title":"Chinese J Aids Std"},{"key":"B53","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1186\/s12913-021-06980-6","article-title":"Socio-demographic, clinical and service use determinants associated with Hiv related stigma among people living with hiv\/aids: a systematic review and meta-analysis","volume":"21","author":"Armoon","year":"2021","journal-title":"Bmc Health Services Res"},{"key":"B54","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1007\/s10461-021-03358-x","article-title":"Effectiveness of Hiv stigma interventions for men who have sex with men (Msm) with and without HIV in the United States: a systematic review and meta-analyses","volume":"26","author":"Gunn","year":"2022","journal-title":"Aids Behav."},{"key":"B55","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1080\/09540121.2018.1563282","article-title":"Impact of pre-diagnosis awareness of Hiv-related stigma and dispositional coping on linkage to Hiv care among newly diagnosed Hiv+ peruvian patients","volume":"31","author":"Molina","year":"2019","journal-title":"AIDS Care."},{"key":"B56","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1186\/s12879-019-4156-3","article-title":"Late Presentation of Hiv positive adults and its predictors to Hiv\/aids care in Ethiopia: a systematic review and meta-analysis","volume":"19","author":"Belay","year":"2019","journal-title":"BMC Infect Dis."},{"key":"B57","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1186\/s12913-018-3245-0","article-title":"Hiv-related stigma among people living with HIV\/aids in rural central China","volume":"18","author":"Li","year":"2018","journal-title":"BMC Health Serv Res."},{"key":"B58","doi-asserted-by":"publisher","first-page":"744","DOI":"10.53738\/REVMED.2020.16.690.0744","article-title":"[Stigma And Hiv: Relevant For Everyone]","volume":"16","author":"Cobos Manuel","year":"2020","journal-title":"Rev Med Suisse."},{"key":"B59","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1097\/QAD.0000000000000125","article-title":"Crf01_Ae subtype is associated with x4 tropism and fast HIV progression in Chinese patients infected through sexual transmission","volume":"28","author":"Li","year":"2014","journal-title":"Aids."},{"key":"B60","doi-asserted-by":"publisher","first-page":"E0191671","DOI":"10.1371\/journal.pone.0191671","article-title":"Prevalence Of actual uptake and willingness to use pre-exposure prophylaxis to prevent HIV acquisition among men who have sex with men in Hong Kong, China","volume":"13","author":"Wang","year":"2018","journal-title":"PLoS One."},{"key":"B61","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1186\/s12879-021-06490-0","article-title":"The impact of Covid-19 pandemic On Hiv care continuum In Jiangsu, China","volume":"21","author":"Shi","year":"2021","journal-title":"BMC Infect Dis."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.1054765\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T12:42:15Z","timestamp":1670503335000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.1054765\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,8]]},"references-count":61,"alternative-id":["10.3389\/fpubh.2022.1054765"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2022.1054765","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,8]]},"article-number":"1054765"}}